Natural birth vs elective ceasarian questions

[paniccentral]

26+1 with DC1 and conflicted about the best way to give birth.

Not worried at all about pain (famous last words I'm sure!) but very worried about risks of (long-term) injury from pushing. Read quite a bit about recent campaigns over birth injuries, and DM had a stage 3 tear requiring further repair followed by a huge epis in second delivery, 30 years ago and all bodies are different etc but not at all comfortable with that outcome.

Flip flopping between two options:

1. birthing centre as naturally as poss, reassured by wonderful midwife that she and all her colleagues are very "hands on" and chiefly concerned with physical management of perineum to prevent tears, and their stats are only 6% stage 3 tear or worse, BUT 95% stage 1 or 2, largely not needing stitches.

First question - if a tear doesn't need stitches or only needs a couple for a stage 2, does that = return to normal (sex) life, pain free?

2. Her advice has been to reject forceps if it comes to it, and at that stage ask to go for a ceasar instead. Happy to prepare for that but equally if the odds, and I know nobody can tell what the odds are, of going that way are good enough then why not sod the worry and book in for a c-section from the get go?

Have an appt to speak with the consultant obstetrician re planned ceasarian next month and want to be prepared. I guess I want to know why c-sections are considered so "bad" - I know they take longer to recover from, there are risks inherent with surgery and the baby doesn't have the same exposure to antibodies en route out (and it costs the NHS more) - but if the difference is a known quantity "routine" surgery vs nobody knows how a vaginal delivery will go on the day, and worst case is pretty awful, it feels almost like the safer bet?

Are there any other questions I should be asking him? I feel naive and don't want to be judged for asking about this (feel like it's hard IRL to ask other girlfriends etc in case it's "a bad thing", don't know why it should be but feels that way!) but really keen to get the most out of the opportunity.

Saw Kate Middleton's PA at home with her first baby +15 hours since going in with two paracetamol, gas and air on instagram yesterday (looking a bazillion dollars) and thought well if she can do it why would you inflict a six week surgical recovery on yourself... but if only I knew it would be sure to go that way!!!

Hope this isn't too muddled, thanks in advance for any thoughts x

I used to work with gynaecologists and obstetricians. All the female ones (obvs!) had electives. Which told me all I needed to know TBH

I've had two emcs and am now booked in for a planned cs with dc3.

I would have another go at a vaginal birth with dc1 if I had my time again. Emcs was very quick slick recovery was good.

Emcs2 was more of a nightmare. Another long latent labour, back to back, brow presentation, long pushing stage this time tho, refused forceps as ds was stuck up high and consultant wanted to do rotational forceps, er no thanks, long cs due to scar adhesions, excellent physical recovery, gorgeous baby, bf fine, but i was traumatised. Therapy for post traumatic stress. All good now.

Planned section coming up unless dc3 had other plans lol.

Always chance a normal vaginal delivery.
CS are very good and safe generally - we are very very lucky to have them but you might have a good vaginal delivery which I have no doubt would be awesome.

CS put your future pregnancies at risk. Statistically I mean, not definitely. After 3 CS, risks go up by quite a lot. Of all sorts of things, one in particular being dodgy placement of placenta which imo is quite important.

Google 'mumsnet stories of quick easy labours', get inspired, have a go, you can always have an emcs if it's not happening. Personally I didn't think emcs that bad in some ways as baby had started the labour so was ready etc. I'd rather wait for labour to start this time around but logistically hard for hospital. I've arranged 39+2 as that's when other two labours started but we'll see.

Childbirth such a gamble in so many ways. Best of luck xx

I haven't missed the point. I am giving my actual experience. You're giving second hand scare stories.

My sister has had a natural birth , emergency section and a planned section her opinion is that they are all
As shit as each other but she likes the planned element of her last birth

I think it's as important to get into good shape for a Cs as for any major event. Recovery both times for me was great. Biological nurturing style helped with bfing but generally it genuinely wasn't that bad. I'm generally in good enough shape tho. Eat well drink water exercise as possible in pregnancy etc.

One friend did say as I was umming and aahing about homebirth vs planned section 'if uve avoided vaginal birth thus far, def go for section, cant believe I was even questioning it lol' ... but hers were difficult exits - shocking number of stitches etc never same vag again.

Really is such a spectrum of experience. Another two friends had pph after vag birth which sounded like an absolute nightmare. One of them wee comes out when she runs. Pregnancy will do some of it - I have to go for a wee before going on trampoline lol but my sister was laughing no way she can even go on one and she had two normal vag births.

Main thing from my second was there was a point where I thought we wld die and I can def see how that might happen in an obstructed labour, it went on so long - shock etc, but honestly the emcs itself was a blessed relief and I was most grateful to the surgeon!

Sorry essay! I just dont think women need to fight over this stuff. It can be a minefield and people need to be able to do whatever they choose to.

When I say exercise mean walking reasonably. I know some women really really exercise lol but i just mean heart pumping blood moving walking dog round block at 36 weeks!

Friend had 3 emergency CS followed by a planned CS; the emergency CS were all fine. She recovered fine from the emCS, never any regrets. But several things went wrong in & after the planned CS. She was quite upset by the planned CS.

Not saying what you should do, but I couldn't embrace illusion that everything will be under control with planned CS. Just like babies themselves: you aren't in control of everything about your growing baby, either.

After spending 60 hours in labour through induction only for it to end in EMCS, if I had my time again I would go for planned section. Then that 60 hours that was wasted in labour could have been spent getting better & getting out of hospital quicker & not going through the horrific pain of an induced labour.

Her advice has been to reject forceps if it comes to it, and at that stage ask to go for a ceasar instead

I think if I'd have needed an instrumental delivery I'd have refused and requested a section though.

It doesn’t work like that. If you are at the point where instruments might be needed then baby will have descended too far into the birth canal for a CS to be a straightforward option. It is possible to push the baby back up but this is as brutal as it sounds and not without risks.

Well I am far more sensitive down there since giving birth, sex feels better than it ever has before.

Same with me. I seem to orgasm much easier/quicker since my last vaginal birth.

Saying you would request a caesarean over forceps sounds good in theory but is not a well-informed opinion. By the time forceps becomes an option, then a caesarean can become a difficult option. Second stage caesareans have an increased risk of additional complications, both for that delivery and subsequent pregnancies. There has to be an element of trusting the caregivers to deliver in the safest way they can. Again, with the elective caesarean option it isn't just this this birth to take into account, it’s the risks in subsequent pregnancies. They likelihood may be small but is they happen they can be devastating. Obviously, for you they may be risks worth taking, but there is no risk free option.

I had my first baby just over three weeks ago. I started out really well and got to fully dilated in the pool on just gas and air but unfortunately my son rotated to direct OP and I couldn’t push him out so I ended up with all the things I didn’t want: failed Kiellands forceps, sucessful Neville Barnes forceps, 3rd degree tear and 1.5l postpartum haemorrhage.

The thing is, if I had the choice to go back in time and have an elective section knowing I could avoid all of that, I wouldn’t want to. I couldn’t imagine not knowing what it felt like to experience labour and I feel a huge sense of pride for getting as far as I did. It was kind of like climbing a mountain: tough at the time but a huge sense of achievement when I made it to the top. I look back on it as a positive experience despite the complications.

Recovery-wise the first week post delivery was physically tough but I am now pretty much back to normal: stitches have healed well and no problems with continence.

Oh, and just to balance out the “doctors all choose elective section” comments that come up on these threads, I am a doctor!

I’ve had both. Vaginal was better. Recovery was so much quicker and the pain was similar as I had to have an ECS after hours or unproductive labour with my C section. After a c ration your stomach muscles are not the same imo

Oh yes ... on the doctor thing, obstetric doctors in the UK by definition see complicated births. They’re involved in instrumentals etc, not the normal births which make up the majority of deliveries. Which may explain why some of them may opt for elective caesareans.

I had forceps and a 3rd degree tear and have permanent problems as a result. Next DC was an elective C section, and in comparison, the recovery was easy.

I have always thought the same as you... i.e. ceasarean generally goes to plan and can be well managed. whereas natural birth.... so many things can go wrong. Plus i remember reading a female doctor saying they would opt for ECS. Having had two pretty difficult births, lots of tearing and stitches and an altered sex life... I'd probably go for ECS if I had my time again.

My friends who are docs & 1 surgeon all had VB so I think it just depends. Pregnancy alone can cause prolapse & incontinence.

I’ve had both. Dc1 had to be induced & I was terrified of forceps etc. In reality I had a pessary & no other intervention, I went from 0-100 super fast. No time for pain relief & baby was crowning as I got on the gas & air (active labour 1.5 hours). Not going to lie the contractions were so painful but the actual pushing not that bad. Had a very mild 2nd degree tear with a few stitches. Was up after a nap & felt a little tender & sore all over as if I had done intense exercise. That was it, no other issues & actually felt like I hadn’t given birth. Although I had the pushing sensation in my bum & had done lots of yoga so that may have helped.
Loads of probs throughout dc2 pregnancy & ended up with semi elective CS. I had a good recovery I was told & was discharged the next day with paracetamol but the pain for the first 3 days was bad. Yes I could walk but more of a zombie shuffle & my body does not feel the same 2 years later. I just don’t like the fact I was cut open (very neat scar) & I know it was the safest option for baby but feel my stomach & back are much weaker. If I have another I want a VB.

I had a vaginal delivery and am glad I did. I did tear and did need stitches, they healed well and it hasn't affected my sex life. I used gas and air for pain relief.

I never really considered having elective surgery instead of a natural birth tbh. I found the following for you though :

Planned caesarean section may reduce the risk of the following in women:

• pain in the area between the vagina and anus (perineum) and in the abdomen (tummy) during birth and 3 days afterwards
• injury to the vagina
• heavy bleeding soon after birth
• shock caused by loss of blood.

Planned caesarean section may increase the risk of the following in babies:

• intensive care unit admission.

Planned caesarean section may increase the risk of the following in women:

• longer hospital stay
• bleeding after the birth that needs a hysterectomy (removal of the
womb)
• heart attack.

www.theguardian.com/politics/reality-check-with-polly-curtis/2011/nov/23/health

2 waterbirths, awesome, no issues. All good

I had two planned sections due to both being breach.

First was awful. It was painful during (even with spinal) and they were very close to putting me under general. I had a 1.8 litre PPH afterwards and had to spend 25 hours in HDU and I needed a transfusion. I needed someone to help me with everything for 2 days as I was so weak. I managed to breastfeed, looking back I don't know how. I couldn't move up and down in bed and recovery took a long long time.

My second c section was great. I had a bit of a bleed (was officially a PPH but was not as much as the first) but I was up and about the next day and recovery was amazing.

With both I couldn't have sex until well after 6 months as I was too tight and it was really painful. I didn't realise that it's common, I think something to do with muscles contracting?

I think of it this way. If you've a serial killer coming at you with a scalpel, and you've the option of offering your tummy or your fandango to be cut, which would you chose

I actually don't know what a 2nd degree tear is. Let alone a 3rd degree tear . Is that where your fanny rips open or something? Christ of almighty, I've never asked this before, because I probably don't want to know the answer. Which end of it rips, the ass end or the front end?
Sorry to be gruesome, but it's just not something you're taught!

It's hugely personal and unfortunately you don't know what you'll get until it happens. I've had two emergency sections and quite literally bounced back physically despite the extremely long labour/failed forceps with dc1 but I'm definitely an outlier (no need for pain relief, walking straight backed to NICU within 24 hours with dc1 and out for lunch/dancing at Messy Church on day 2 with dc2).

Apparently the older you are, the higher the risk of tearing badly. I think I read somewhere it's a 20 percent chance of anal sphincter tear by age 40.

Emergency sections at full dilation are also more risky than in the earlier stage of labour so rejecting forceps is not so black and white as it sounds your midwife suggested. I would however reject rotational forceps as I've heard absolutely nothing good about them.

Bear in mind as well that they won't do an elective before 39 weeks until there are medical grounds. Dc2 was meant to be an elective but was already in my arms by the time my slot rolled around even though it was booked for 39+1 and I went into labour with dc1 at 38+4. So even if you decide an elective is the best option for you, make a plan for what you would do if baby decides they want to decide their birthday.

All I can say is that if you are the unlucky one who has a third degree tear and episiotomy as well, followed by prolapse, then it’s hard to imagine why we ever take the risk!

Second time around I had ELC. No regrets.

The damage from the first birth and consequences for my health and happiness I will have to live with for the rest of my life.

I was so so in favour of natural birth and was in a supposedly very safe place with an experienced midwife. I would never take that risk again. I’d honestly rather die in a csection than experience it again. I know people will say I’m panicking people and it probably won’t happen. But I wish someone had been honest with me. In real life no one would know the consequences and I rarely speak about it.

I was relatively young I guess (27), so recovery was quite easy. You do feel like you've been through the wars, but a baby needing incessant attention will do that to you anyway, whatever way the cat jumps.
It's probably good advice that the previous poster gave, to prepare yourself for maybe having to go through a natural birth anyway, even if you decide on the C-section route, as I imagine, if you're all planned for some calm surgery, and then you go into labour, it might be a bit traumatic.

Babies are unpredictable little creatures.